6-8-11: A Setting for Birth

June 8, 2011 at 11:12 am 6 comments

In May, a midwife based in Maryland pleaded guilty in Virginia to two felonies stemming from the death of a baby after a home birth.  That midwife, Karen Carr, is now being investigated by St. Mary’s County in another death in rural Maryland in November.  Last month, we spoke with Karen Carr about how she practices midwifery.

We wanted to take a closer look at the practice of midwifery in Maryland, generally.  In the U. S., the majority of midwife-attended births take place in hospitals…but many people still associate midwives with births that take place outside the hospital—at home, or in a free-standing birth center.

According to data from the Centers for Disease Control, in 2006, fewer than 1 percent of all births in Maryland took place outside of a hospital—though that number is rising.  The CDC found that the number of mothers opting for out-of-hospital birth had risen by 35 percent from three years prior.

In this segment, we hear perspectives from those who are familiar with midwife-attended births– at home, in birth centers, and in hospitals–and we discuss the possible problems when a direct-entry midwife (who may not be licensed) must transfer care to a physician at a hospital.

Brigitte Jacobson is a former Navy pilot who gave birth to her second child at her home in Baltimore.  In this web extra, you can hear Brigitte describe the process of deciding to give birth at home–her son arrived before the midwife did:

We also talk with Ann Sober, a nurse who is director of a birth center in Arnold, north of Annapolis.  It’s called “Special Beginnings Birth and Women’s Center.”  Ann also established a birth center in Baltimore thirty years ago, before birth centers were licensed in Maryland.  In this additional web extra, you can hear her talk about that process:

We also speak with Erin Wright, a certified nurse-midwife who practices at a hospital through the University of Maryland, about the process of having a midwife-attended birth in a hospital.  Erin is also president of the Maryland Chapter of the American College of Nurse-Midwives.

In this segment, we didn’t speak with an OB-GYN or hospital official – we’re looking forward to doing that in future coverage.

We’d also like to hear about your own birth experiences, whether it was at home, in a hospital, with a midwife or a doctor – leave us a comment, email us at mdmorning@wypr.dot.org, or give us a call at 410-881-3162.

Entry filed under: Health, On Air. Tags: , , , .

6-8-11: The Arts of Pennsylvania Avenue Coming Up on MDM: Friday 6-10-11

6 Comments Add your own

  • 1. Ann Cowlin  |  June 9, 2011 at 9:15 am

    A very necessary discussion.

    Reply
  • 2. Erin Brickner  |  June 9, 2011 at 10:18 am

    Thank the goddesses that someone is doing the work that needs to be done to bring women back to the power they have to give birth and have it be a wonderful life affirming event instead of a power competition between medical interventions and woman crowning her own birth with her baby. I am unable to talk to my daughter three months after the birth of her baby because I am still so upset with the medical decisions made by the staff that scared her so much and all the intervention after she had wanted an unmedicated birth. Her husband who has a medical background because of his mother being an ER nurse thought the whole thing should be medically managed and was scared to death by the midwives and nurses at the hospital who convinced him his wife would die without their help. He was led right down the wolf’s path. Thy ended up with a 70.000 dollar bill and their baby in NICu all because as first time parents they were scared. Their baby was induced early and separated from them for a week. By the end of that week, I was not allowed to talk to my daughter anymore and am now banned because I know how they were railroaded and they think I have condemned their choices. Because I was limited in the time I was allowed to spend with the baby and my daughter (only two people at a time during visiting hours), I was not able to help my daughter nurse for the first time or even see her nurse her baby. She is now no longer nursing as she did not get the follow up care she needed even with a 70,000 bill. I never saw her nurse her baby. As a former LLL leader it hurts my heart to see this happen to my daughter who was raised as a toddler serving tea to all the mothers in our LLL meetings. I live very ten hours away and was advised by the social worker that I should leave because of all the consternation caused by my son in law’s drama around the attendance of my daughter’s needs. I was “too helpful” in establishing her milk supply. He then proceeded to give the baby all the pumped milk after I left for every feeding instead of waking up my daughter which led to further complications in establishing her milk supply.

    Reply
  • 3. Catherine M Salam  |  June 9, 2011 at 3:46 pm

    I would like to comment on the discussion during the June 8th interview of what happens on the receiving end of a home birth transfer. I am a Certified Nurse-Midwife at Maryland General Hospital in Baltimore. We have received clients from Ms. Carr either to our office at 42 weeks gestation, or with pregnancy complications, or in labor with conditions such as failure to progress, as Ann Sober mentioned. We manage these conditions in collaboration with our attending physician — but the midwives are the primary, hands on provider of care for the labor and birth. We do our utmost to respect the birth plan of the couple, acknowledge the grief process in a situation of losing their intended birth experience, and sometimes find ourselves in conflict with them over the concept of “safety” for mother and baby. Bridget raised a good point in asking if the outcome for the baby is the ultimate good? Another question is whether autonomy for the mother is the ultimate good? When there is a perceived conflict between these two positions, there is stress for all involved.
    Look forward to the continuation of the discussion on Friday.
    Catherine

    Reply
  • 4. Laura  |  June 10, 2011 at 9:30 am

    Years ago after a normal pregnancy I gave birth slightly early to a beautiful healthy girl. Immediately after the birth I began to hemorrhage heavily and had to be rushed into the operating room for an emergency D&C. The placenta had attached to the uterus wall and the bleeding was caused when it was delivered. I was told that I came very close to losing my life.
    I don’t understand how a mother can put her life and the life of her baby’s at risk just to have a child out of a hospital setting.

    Reply
  • 5. Brigitte  |  June 12, 2011 at 9:15 am

    Hi Laura, I’m the Brigitte from the interview and while I understand your opinion given your birthing experience I think that the safety or danger of home birth can’t be determined by any one person’s experience. Otherwise, following that logic, when women or babies die at the hospital (often after having pregnancies that were characterized as being “low risk”) that would suggest that hospital births were inherently unsafe and yet very few people take that position.

    My husband and I chose to have a home birth not because we knew of a few women who had had positive experiences but because *statistically* planned home birth for low-risk pregnancies has been shown to be as safe as hospital births. We knew that we weren’t guaranteed a perfect birthing scenario at home (just as we wouldn’t have been at the hospital). But we also knew that midwives, just like obstetricians, are trained to handle birthing emergencies should they occur and because the midwife that we chose was a certified nurse midwife, operating legally within the state, we knew that she wouldn’t hesitate to suggest a transfer if that became necessary. And because midwives (unlike obstetricians) are accustomed to attending natural births, a midwife would be more capable of helping us to achieve the natural birth that we wanted. We also hired a doula who, in addition to being a certified professional labor assistant, had worked as a labor and delivery nurse, was a volunteer firefighter, and an EMT.

    We ultimately chose to go with a home birth not because I’m a control freak or because we’re afraid of hospitals but because natural child birth was very important to us both for my own health and safety and for the health and safety of the baby I was carrying. I think a c-section or any medical intervention is a wonderful thing for women who truly need it. The crucial issue that confronts us all in a time when one-third of women are determined to “need” a c-section is why so many of them need them all of a sudden. Women’s bodies aren’t becoming increasingly defective and unable to push their children out. If they are, that seems to only be happening in America (and places like Brazil where up to 90% of women have c-sections).

    I believe that health care professionals should practice evidenced-based medicine and there’s not a lot of that happening in hospitals across the country these days. I chose to give birth out of the hospital not because my autonomy was more important than the safety of my baby but because I wanted to avoid the very medical interventions that usually result in more medical interventions and ultimately drugs, a vacuum extraction, or a c-section and statistically I had a far better chance of having a healthy baby naturally outside of the hospital than in it.

    Brigitte

    Reply
  • 6. Margo  |  June 12, 2011 at 10:29 am

    Laura,
    The experience you had, a postpartum hemorrhage, is a fairly straightforward complication that midwives are equipped to start dealing with at home with the same drugs they would give you in the hopsital, leaving plenty of time for transport to a hospital where they can pick up where the midwives left of to deal with any underlying issues (retained placenta, retained blood clots, etc). The placenta is always attached the the uterine wall, and there is always bleeding when it is delivered, so there was nothing special about your experience except that you were one of the few people that continues bleeding for one of the aforementioned reasons.

    Some women would ask you the same question- why would you put your life and your babies life at risk just to have your baby in a hospital? You’re more likely to have a c-section there, which carries 5 times the risk of maternal death. Go ahead and make your choices but let others make their own.

    Reply

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